A description of 60 cases of extreme osteonecrosis and osteomyelitis of the jaws is presented. The patients attended the dental clinics of the medical charity organisation Mercy Ships, over a 2.5-year period when the hospital ship the ‘Africa Mercy’ was docked in the West African countries of Liberia, Benin and Togo. Possible reasons for the development of these clinical conditions are discussed including aetiologies, genetics (coagulopathies, osteopetrosis), Gorham’s disease, infective conditions (tuberculosis, herpes zoster, HIV infection, osteomyelitis), toxicity (bisphosphonates, spider bites), and environmental effects (phossy jaw, radium jaw). The possible causes of these cases of osteonecrosis and osteomyelitis of the jaw are under investigation.
Osteonecrosis of the jaw (ONJ) refers to necrotic bone that may or may not be exposed, regardless of the aetiology. The causes of ONJ have been categorized as: use of systemic medications; radiation; infection; direct chemical toxicity; trauma; idiopathy; and other aetiologies. Osteomyelitis, in contrast to ONJ, starts as an infective inflammation of the medullary cavity of bone. The initial insult in osteonecrotic lesions may not be infection, but a compromised blood supply and subsequent local tissue death and osteonecrotic development from underlying thrombotic and haemorrhagic processes.
The authors present 60 cases of extreme ONJ in the mandible and maxilla in a West African population that has not had access to modern medical treatment and lives in a compromised nutritional and sanitary environment.
Materials and methods
The case series included 60 patients diagnosed with an extreme ONJ condition. The patients were all part of the indigenous population of West Africa treated in the countries of Liberia, Benin and Togo. Over 40% of the population is under the age of 20 years in all three countries ( Table 1 ).